The association between prenatal per-and polyfluoroalkyl substance levels and Kawasaki disease among children of up to 4 years of age: A prospective birth cohort of the Japan Environment and Children's study

Impact of prenatal exposure to per- and polyfluoroalkyl substances on developmental delays in 4-year-old children: The Japan Environment and Children's study

Although per- and polyfluoroalkyl substances (PFAS) have raised global concern due to their adverse effects on children's development, the association between prenatal exposure to PFAS and the achievement of developmental milestones in preschool children remains unclear. This study aimed to examine the individual and cumulative associations between prenatal PFAS and developmental delay in 4-year-old children. We used data from 15,131 mothers (15,175 children) in the Japan Environment and Children Study (JECS), an ongoing nationwide prospective birth cohort. Among 28 PFAS measured in maternal plasma, eight with detection frequencies ≥ 60 % were analyzed. Developmental delays were assessed using the Japanese version of the Ages and Stages Questionnaires third edition (JASQ-3), a self-administered screening tool, with suspicion of developmental delay indicated by total scores falling below the Japanese version cutoffs for the five JASQ-3 domains (communication, gross motor, fine motor, problem solving, and personal-social). Univariate and multivariable logistic regression analysis and quantile g-computation were applied. Findings revealed that these eight PFAS were not significantly associated with higher odds of developmental delay across any JASQ-3 domain, nor did their combined effects. However, the effects of PFAS substances not measured in this study and the impact of continued postnatal exposure to PFAS on developmental delays remain a concern. Continuous investigation of the effects of PFAS on development throughout the lifespan is necessary.

Assessing large language models as assistive tools in medical consultations for Kawasaki disease

Background

Kawasaki disease (KD) presents complex clinical challenges in diagnosis, treatment, and long-term management, requiring a comprehensive understanding by both parents and healthcare providers. With advancements in artificial intelligence (AI), large language models (LLMs) have shown promise in supporting medical practice. This study aims to evaluate and compare the appropriateness and comprehensibility of different LLMs in answering clinically relevant questions about KD and assess the impact of different prompting strategies.

Methods

Twenty-five questions were formulated, incorporating three prompting strategies: No prompting (NO), Parent-friendly (PF), and Doctor-level (DL). These questions were input into three LLMs: ChatGPT-4o, Claude 3.5 Sonnet, and Gemini 1.5 Pro. Responses were evaluated based on appropriateness, educational quality, comprehensibility, cautionary statements, references, and potential misinformation, using Information Quality Grade, Global Quality Scale (GQS), Flesch Reading Ease (FRE) score, and word count.

Results

Significant differences were found among the LLMs in terms of response educational quality, accuracy, and comprehensibility (p < 0.001). Claude 3.5 provided the highest proportion of completely correct responses (51.1%) and achieved the highest median GQS score (5.0), outperforming GPT-4o (4.0) and Gemini 1.5 (3.0) significantly. Gemini 1.5 achieved the highest FRE score (31.5) and provided highest proportion of responses assessed as comprehensible (80.4%). Prompting strategies significantly affected LLM responses. Claude 3.5 Sonnet with DL prompting had the highest completely correct rate (81.3%), while PF prompting yielded the most acceptable responses (97.3%). Gemini 1.5 Pro showed minimal variation across prompts but excelled in comprehensibility (98.7% under PF prompting).

Conclusion

This study indicates that LLMs have great potential in providing information about KD, but their use requires caution due to quality inconsistencies and misinformation risks. Significant discrepancies existed across LLMs and prompting strategies. Claude 3.5 Sonnet offered the best response quality and accuracy, while Gemini 1.5 Pro excelled in comprehensibility. PF prompting with Claude 3.5 Sonnet is most recommended for parents seeking KD information. As AI evolves, expanding research and refining models is crucial to ensure reliable, high-quality information.

The association between ozone exposure and blood pressure in a general Chinese middle-aged and older population: a large-scale repeated-measurement study

BACKGROUND

The relationship between ozone (O3) exposure and blood pressure (BP) remains inconclusive. Given the scarcity of Chinese epidemiological data, more research on this association is of paramount importance, particularly among middle-aged and older Chinese populations.

METHODS

This study involved 10,875 participants (median age: 60.0 years) in Xiamen, China, from 2013 to 2019, with 34,939 repeated BP measurements. Air pollutant exposure data, including O3, particulate matter, nitrogen dioxide, sulfur dioxide, and carbon monoxide were derived from China High Air Pollutants and High-resolution Air Quality Reanalysis datasets using a k-nearest neighbor algorithm. The relationship between mixed air pollutant exposure and BP was evaluated using Bayesian kernel machine regression model. The effects of daily-specific O3 exposure on BP were assessed by distributed lag models integrated into a linear mixed-effects framework. The mediating role of total cholesterol (TC), serum total bilirubin (STB), triglyceride (TG), and low-density lipoprotein (LDL) were examined using multilevel mediation analysis with a fully adjusted model.

RESULTS

Mixed air pollutant exposure was positively correlated with BP, with O3 being a predominant contributor exhibiting an inverse effect. O3 exposure had immediate effects on pulse pressure (PP), while systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) showed delayed responses, with 3-, 14-, and 8-day lags, respectively. During the study period of up to 30 days, each 10 μg/m3 increase in maximum daily 8-h average O3 concentration was associated with reductions in SBP (β =  - 1.176 mm Hg), DBP (- 0.237 mm Hg), PP (β =  - 0.973 mm Hg), and MAP (β =  - 0.544 mm Hg). Stronger correlations were observed in the older participants (aged ≥ 65 years), overweight/obese individuals, smokers and alcohol consumers, and those with hypertension or type 2 diabetes mellitus. STB and LDL mediated these effects, while TC and TG played mitigating roles.

CONCLUSIONS

Short-term O3 exposure is negatively associated with BP in middle-aged and older Chinese individuals. The findings provide preliminary evidence for the impact of O3 exposure on BP regulation and underscore the urgent need to reassess public health policies in response to O3 pollution.

Relationships between minerals' intake and blood homocysteine levels based on three machine learning methods: a large cross-sectional study

BACKGROUND

Blood homocysteine (Hcy) level has become a sensitive indicator in predicting the development of cardiovascular disease. Studies have shown an association between individual mineral intake and blood Hcy levels. The effect of mixed minerals' intake on blood Hcy levels is unknown.

METHODS

Data were obtained from the baseline survey data of the Shanghai Suburban Adult Cohort and Biobank(SSACB) in 2016. A total of 38273 participants aged 20-74 years met our inclusion and exclusion criteria. Food frequency questionnaire (FFQ) was used to calculate the intake of 10 minerals (calcium, potassium, magnesium, sodium, iron, zinc, selenium, phosphorus, copper and manganese). Measuring the concentration of Hcy in the morning fasting blood sample. Traditional regression models were used to assess the relationship between individual minerals' intake and blood Hcy levels. Three machine learning models (WQS, Qg-comp, and BKMR) were used to the relationship between mixed minerals' intake and blood Hcy levels, distinguishing the individual effects of each mineral and determining their respective weights in the joint effect.

RESULTS

Traditional regression model showed that higher intake of calcium, phosphorus, potassium, magnesium, iron, zinc, copper, and manganese was associated with lower blood Hcy levels. Both Qg-comp and BKMR results consistently indicate that higher intake of mixed minerals is associated with lower blood Hcy levels. Calcium exhibits the highest weight in the joint effect in the WQS model. In Qg-comp, iron has the highest positive weight, while manganese has the highest negative weight. The BKMR results of the subsample after 10,000 iterations showed that except for sodium, all nine minerals had the high weights in the joint effect on the effect of blood Hcy levels.

CONCLUSION

Overall, higher mixed mineral's intake was associated with lower blood Hcy levels, and each mineral contributed differently to the joint effect. Future studies are available to further explore the mechanisms underlying this association, and the potential impact of mixed minerals' intake on other health indicators needs to be further investigated. These efforts will help provide additional insights to deepen our understanding of mixed minerals and their potential role in health maintenance.

Associations of per- and polyfluoroalkyl substances (PFAS) and their mixture with risk of rheumatoid arthritis in the U.S. adult population

BACKGROUND

Per- and polyfluoroalkyl substances (PFAS) are known environmental contaminants with immunosuppressive properties. Their connection to rheumatoid arthritis (RA), a condition influenced by the immune system, is not well studied. This research explores the association between PFAS exposure and RA prevalence.

METHODS

This research utilized data from the NHANES, encompassing a sample of 10,496 adults from the 2003-2018 cycles, focusing on serum levels of several PFAS. The presence of RA was determined based on self-reports. This study used multivariable logistic regression to assess the relationship between individual PFAS and RA risk, adjusting for covariates to calculate odds ratios (ORs). The combined effects of PFAS mixtures were evaluated using BKMR, WQS regression, and quantile g-computation. Additionally, sex-specific associations were explored through stratified analysis.

RESULTS

Higher serum PFOA (OR = 0.88, 95% CI: 0.79, 0.98), PFHxS (OR = 0.91, 95% CI: 0.83, 1.00), PFNA (OR = 0.87, 95% CI: 0.77, 0.98), and PFDA (OR = 0.89, 95% CI: 0.81, 0.99) concentration was related to lower odds of RA. Sex-specific analysis in single chemical models indicated the significant inverse associations were only evident in females. BKMR did not show an obvious pattern of RA estimates across PFAS mixture. The outcomes of sex-stratified quantile g-computation demonstrated that an increase in PFAS mixture was associated with a decreased odds of RA in females (OR: 0.76, 95% CI: 0.62, 0.92). We identified a significant interaction term of the WQS*sex in the 100 repeated hold out WQS analysis. Notably, a higher concentration of the PFAS mixture was significantly associated with reduced odds of RA in females (mean OR = 0.93, 95% CI: 0.88, 0.98).

CONCLUSIONS

This study indicates potential sex-specific associations of exposure to various individual PFAS and their mixtures with RA. Notably, the observed inverse relationships were statistically significant in females but not in males. These findings contribute to the growing body of evidence indicating that PFAS may have immunosuppressive effects.

Binding Affinity and Mechanism of Six PFAS with Human Serum Albumin: Insights from Multi-Spectroscopy, DFT and Molecular Dynamics Approaches

Per- and Polyfluoroalkyl Substances (PFAS) bioaccumulate in the human body, presenting potential health risks and cellular toxicity. Their transport mechanisms and interactions with tissues and the circulatory system require further investigation. This study investigates the interaction mechanisms of six PFAS with Human Serum Albumin (HSA) using multi-spectroscopy, DFT and a molecular dynamics approach. Multi-spectral analysis shows that perfluorononanoic acid (PFNA) has the best binding capabilities with HSA. The order of binding constants (298 K) is as follows: "Perfluorononanoic Acid (PFNA, 7.81 × 106 L·mol-1) > Perfluoro-2,5-dimethyl-3,6-dioxanonanoic Acid (HFPO-TA, 3.70 × 106 L·mol-1) > Perfluorooctanoic Acid (PFOA, 2.27 × 105 L·mol-1) > Perfluoro-3,6,9-trioxadecanoic Acid (PFO3DA, 1.59 × 105 L·mol-1) > Perfluoroheptanoic Acid (PFHpA, 4.53 × 103 L·mol-1) > Dodecafluorosuberic Acid (DFSA, 1.52 × 103 L·mol-1)". Thermodynamic analysis suggests that PFNA and PFO3DA's interactions with HSA are exothermic, driven primarily by hydrogen bonds or van der Waals interactions. PFHpA, DFSA, PFOA, and HFPO-TA's interactions with HSA, on the other hand, are endothermic processes primarily driven by hydrophobic interactions. Competitive probe results show that the main HSA-PFAS binding site is in the HSA structure's subdomain IIA. These findings are also consistent with the findings of molecular docking. Molecular dynamics simulation (MD) analysis further shows that the lowest binding energy (-38.83 kcal/mol) is fund in the HSA-PFNA complex, indicating that PFNA binds more readily with HSA. Energy decomposition analysis also indicates that van der Waals and electrostatic interactions are the main forces for the HSA-PFAS complexes. Correlation analysis reveals that DFT quantum chemical descriptors related to electrostatic distribution and characteristics like ESP and ALIE are more representative in characterizing HSA-PFAS binding. This study sheds light on the interactions between HSA and PFAS. It guides health risk assessments and control strategies against PFAS, serving as a critical starting point for further public health research.

Is Japan at low risk for PFAS immunotoxicity?: human biomonitoring study in contaminated areas in Japan

BACKGROUND

Per- and polyfluoroalkyl substances (PFAS) are now considered global contaminants posing health risks. Recent human biomonitoring data in Japan are presented.

METHODS

Human biomonitoring data from Japan, dating back to 2000, were reviewed. In addition, 399 serum samples collected in a primary care clinic in Urayasu City, Okinawa Island-one of the highest PFAS-exposed areas in Japan-between 2021 and 2022 were analyzed. Serum levels of four PFAS were compared with risk levels based on the assessment by Sonne et al. and the European Food Safety Agency.

RESULTS

The PFAS levels in the general population from various areas other than Hokkaido (16.1-43.5 ng/mL) are classified at moderate to severe risk for immunotoxicity based on the assessment.

CONCLUSIONS

A portion of the Japanese population has had high exposure to PFAS and was at high risk of immunotoxicity, and this situation remained in PFAS-contaminated areas in the 2020s.